While group health insurance plans are common, here’s a few reasons why employers shouldn’t overlook dental health benefit plans, too
Story by Lee Marie Reinsch
We associate them with cringe-inducing drills and humiliating inquisitions about how often we (don’t) floss.
Or we link them with cosmetic endeavors like those bleached-to-the-point-of-blinding white teeth that our friends from high school suddenly turn up with.
“The general public often has the idea that the dentist is just for your teeth,” said Dr. Wyn Steckbauer, owner of Glacier Dental in Oshkosh. “We really should be thought of as physicians of the oral cavity. You aren’t just looking at teeth, you are looking at health.”
It’s tempting to skip a couple cleanings. Or even a couple years of cleanings, especially when money’s tight and no Laffy Taffy-curtailing crises arise.
But that kind of nonchalance can end up costing money needlessly in the end, say those in the profession of mouth health. And because dental visits typically aren’t covered by most group health care insurance plans, dental health is a topic employers should be concerned about.
First line of defense
DENTISTS CAN BE THE FIRST LINE OF DEFENSE when it comes to spotting things like oral cancer that a patient may not even know is there.
“Little things can turn into big things,” Steckbauer said.
Even a minor annoyance like a dry mouth can be a sign of something more serious, Steckbauer said, like gum disease or diabetes.
Dental X-rays can scout out bone loss or bone diseases, tumors, abscesses, cysts, growth abnormalities in kids, and even trauma or physical abuse, according to the Journal of the American Dental Association. Dentists can also pinpoint dietary deficiencies, the autoimmune-system problem called Sjogren’s syndrome, and even HIV/AIDS.
So, those twice-yearly checkups that sometimes feel so pointless can actually be a wise investment.
Three out of four Americans have some form of gum disease – from mild gingivitis to periodontitis, according to the American Dental Association. Despite that huge majority, only three in 100 Americans actually get around to seeking help for their gum problems.
So why is this a big deal, and why should employers care?
Because untreated gum disease can lead to some serious – and not to mention costly – long-term health problems: heart disease, rheumatoid arthritis, respiratory diseases, diabetes, blood infections and bone loss – even premature birth and complications during pregnancy, according to the American Academy of Periodontology.
“(Pregnant) women with periodontal disease are twice as likely to contract preeclampsia,” as those without periodontal disease, according to the AAP Web site, www.perio.org. Preeclampsia involves high blood pressure and protein in the urine and can be quite serious.
Several studies have connected dental disease and the chronic inflammation it causes to blocked arteries and strokes, according to the ADA.
Judging from the array of significant health problems linked to dental disease, it might be smarter to stock the employee supply cabinet with toothbrushes rather than Post-Its.
Happiness is a dental plan
IN ORDER TO KEEP OVERALL COSTS DOWN, employers need to consider whether they want their workers to be happy and healthy, according to Brenda Boyd, director of sales for Care Plus Dental Plans, a Milwaukee-based provider of individual and group dental plans. Care Plus has an exclusive relationship with Dental Associates, which has eight dental facilities in eastern Wisconsin, including three clinics in the Fox Cities, one in Fond du Lac and another in Green Bay,
“By providing your employees with a dental plan, you will have happier and healthier employees – they will be inspired to give more back to the company – and you will eliminate things that will keep them out of work,” Boyd said.
Like a group health insurance plan, the investment in dental health pays an employer back over the long-run.
“When an employee is off work, they’re not making money for you,” Boyd said. “Dental care is so closely related to overall health care. When I talk about overall health, a large part of that is dental related.”
Care Plus also provides a supplemental insurance program for those who have other dental coverage. It helps reduce the patient’s overall out-of-pocket expenses, Boyd said. If the employee has dental insurance but it doesn’t kick in until a large deductible gets met, Care Plus can cover the deductible.
Care Plus costs about $40 per year for an individual or $70 for a family, Boyd said.
“It pays for itself rather quickly,” Boyd said.
That’s just one example of the options open to employers and patients.
“We also have managed-care plans that an employer could provide for a lower cost,” Boyd said. “We have plans for individuals without insurance. We really stress the importance of preventive care, the importance of routine exams and X-rays and cleanings.”
It also offers packages for those over 55.
“If we get some of these things right away, we can prevent large out-of-pocket expenses,” Boyd said. “If you are going in on a routine basis, you can usually eliminate needing a crown, which is expensive, because you’ll catch the problem early.”
Saving money makes everybody happy. And it might even be sweeter than a Laffy Taffy habit.
Other issues: Tenderness is a clue
A RED, EVEN SLIGHTLY SORE MOUTH is enough to raise a dentist’s eyebrows.
“What we see more so than anything is the presence of inflammation,” Steckbauer said. “We don’t necessarily know at that point if it’s affecting the rest of the body or if the body is affecting the gums. When we see the presence of inflammation or infection, it cues us in to start asking questions about what might be going on.”
Periodontal disease is a chronic bacterial infection that affects gums and the bones that support the teeth. It starts out as gums that are red, bleeding or puffy, then progresses to soft and spongy gums that pull away from the teeth.
When gums separate from teeth, bacteria can form in the little pockets of space and get into the blood stream through the root of the tooth.
“When it’s a small enough cavity that the patient will say ‘it’s not bothering me,’ we recommend filling it because if you wait until it is bothering you, the infection is in the root and you need a root canal,” Steckbauer said.
Once the infection gets into the tooth root, it’s got an easier chance of hitching a ride into the bloodstream. This isn’t necessarily a huge problem, unless for some reason our defenses have gone south.
“We get exposed to bacteria all the time and if we are healthy and our immune system is intact, we take care of it; it doesn’t (turn) into anything major,” said Kelly Galler, nurse practitioner and heart and vascular clinical coordinator with Bellin Health in Green Bay. “But anybody who is at a higher risk for getting infection will have a harder time fighting it.”
Another reason to keep those dental appointments: The ADA says gum disease can make it harder for diabetics to control their blood sugar. The reverse can be true, as well: Diabetes can make periodontal disease worse by rendering the patient’s system too weak to ward off infection.
Using tobacco can hike up the risk of gum disease, as can changes in hormones, genes and stress. Prescription meds like the Pill, heart drugs and antidepressants can also raise a person’s chances of getting gum disease. Some meds cause dry mouth, and saliva plays a big role in washing bacteria away.
A lousy diet can also add to the risk of gum disease, says the ADA. Not getting enough calcium can put the bones and jaw at risk.
Sue Kamien, public health nutritionist and director of the Outagamie County WIC program, said she’s been seeing way too many kids with rotten teeth in the last few years, likely from juices and other high-sugar drinks in their baby bottles instead of old-fashioned milk.
“When you aren’t drinking milk, you don’t have the strong enamel on your teeth to protect them,” Kamien said.
She estimates 75 percent of the moms she sees know they should get more calcium in their diets but don’t.
“Often it’s because a gallon of milk is $3 and a two-liter bottle of soda is a dollar,” Kamien said. “If (parents) didn’t have milk at home when they were kids, they probably aren’t going to buy it for their own kids.”
Combined with infrequent or nonexistent dental care, it’s not that far of a stretch to imagine that these kids could grow up to be employees who cost their employers more in health care costs than their counterparts who get regular checkups.
PROBABLY THE WORST COMPLICATION of gum disease is infective endocarditis, or inflammation of the heart’s inner lining. It’s caused by bacteria in the bloodstream, most commonly from dental procedures, gastrointestinal tract procedures or genitourinary tract procedures, according to the American Heart Association.
Galler said it can be devastating.
“It can make you very sick and destroys the heart valve and may require heart surgery to repair or replace those valves,” Galler said. “It’s very difficult to get the infection out of the heart.”
Galler recalls one grim case involving a young mother in her 20s who kept returning to the hospital to be treated for such a recurring infection, later believed to have started in her gums. She ended up requiring two open-heart surgeries.
“It destroyed three of her four heart valves, and she was on intravenous antibiotics for months afterward,” Galler said. “This sets her up for problems in the next 30 years, as well.”
Although the case of the young mother is extreme, blood infections in general are not all that unheard of. Galler said she sees around three cases per month of sepsis or similar systemic infections. It’s hard to pinpoint what caused the ones she sees, but since gum disease is so common and also so potentially dangerous, Galler maintains her advocacy of dental health.
“It’s not what we routinely talk about, but I am a proponent of healthy dental hygiene,” Galler said.
An alumna of Ripon College, Lee Reinsch is a freelance writer based in Green Bay.